Individual
DR. SHAD B MACKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
12459 S 300 E STE 202, DRAPER, UT 84020-1899
(385) 430-1200
Mailing address
12459 S 300 E STE 202, DRAPER, UT 84020-1899
(854) 301-2003
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901021479
MI
1223P0700X
Prosthodontics
Primary
10220776-8903
UT
1223P0700X
Prosthodontics
2901021479
MI
Other
Enumeration date
07/28/2015
Last updated
09/19/2023
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